Background:  Highly active antiretroviral therapy (HAART) has substantially reduced mortality due to HIV, but some of these drugs have been linked with metabolic abnormalities, including insulin resistance, diabetes, and other metabolic complications. The purpose of this study was to characterize the extent of metabolic abnormalities in insulin, glucose, and lipids in a cohort of HIV-infected children in Latin America.

Methods:  This is a cross sectional analysis of a long term observational study of a cohort of vertically HIV-infected Latin American children (Brazil, Mexico, and Peru). Participants underwent routine medical history, clinical evaluations and fasting lipids, glucose, and insulin testing. Descriptive statistics were used to describe metabolic abnormalities, including triglycerides >110 (age <10 years) and >150 mg/dL (age > 10 years) and homeostatic model assessment insulin resistance (HOMA-IR) [(fasting insulin x fasting glucose)/405] greater than 2.5 in children (Tanner stage <2) or greater than 4.0 in adolescents (Tanner stage ≥2). The association between HAART and metabolic abnormalities was assessed using Fisher’s exact test.

Results: Among 483 subjects enrolled by June 2009, 258 were eligible for fasting glucose and insulin testing; 143 (55.4%) had results available. Mean (±SD) age at testing was 7.4 (2.0) years; 54% were female, mean (±SD) log₁₀ HIV RNA and CD4% were 2.8 (1.4) and 27.3 (9.8), and 70% were CDC Class B or C. Mean (±SD) duration of ARV therapy at time of testing was 29.4 (23.6) months; 47% were receiving HAART-PI, 24% HAART-NNRTI, 11% non-HAART, and 18% were not receiving ARV. Mean BMI Z-score did not differ among ARV groups (P =0.35). Mean (±SD) insulin and glucose levels were 4.0 (3.0) mcIU/mL and 78.5 (8.0) mg/dL, and HOMA-IR was 0.78 (0.6). All glucose levels were normal; 4.2% of the children were insulin resistant. 11% had cholesterol > 200 mg/dL, 22% had HDL <35 mg/dL, 16% had LDL >130 mg/dL, and 32% had abnormally high triglyceride values. Type of ARV therapy received was associated only with triglyceride abnormalities (P =0.02); levels were highest in those receiving non-HAART and lowest for HAART-NNRTI.

Conclusions:  Insulin resistance and lipid abnormalities were present in this relatively young cohort of HIV-infected children in Latin America. Continued follow up of this cohort and others like it are necessary to characterize the extent of the abnormalities and evolution in settings outside the United States and Europe.